Does asbestos or asbestosis cause carcinoma of the lung?

Our plain-English summary of Does asbestos or asbestosis cause carcinoma of the lung?, by V.L. Roggli, S.P. Hammar, P.C. Pratt, et al (American Journal of Industrial Medicine, 1994).

The study

• Authors: V.L. Roggli, S.P. Hammar, P.C. Pratt, J.C. Maddox, J. Legier, E.J. Mark, A.R. Brody
• Journal: American Journal of Industrial Medicine
• Published: 1994;26(6):835-8
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this commentary, the authors responded to a 1993 editorial by Andrew Churg on whether asbestosis (asbestos-induced interstitial fibrosis) must be present for asbestos to cause lung cancer. They accepted that asbestos exposure is associated with lung cancer but argued that parts of the debate had been understated or omitted. They stated that studies finding no link between lung cancer and asbestos exposure without asbestosis did not report whether they had the statistical power to detect one, and included few such cases. They cited a study of nearly 19,000 lung cancer cases in the west of Scotland that estimated about 5.7% of lung cancers in men there were asbestos related. They also cited a prospective study by Hillerdal that found a modest but statistically significant increased lung cancer risk in people with pleural plaques without radiographic asbestosis. They noted that other lung fibroses carry lower cancer rates and different tumour types. They added that cancers in asbestos workers resemble those of smokers and are predominantly proximal, whereas asbestosis is mainly basilar and subpleural. They considered animal studies of little help. They cited a fibre analysis study linking higher tissue fibre burdens with lower-lobe tumours after adjustment for smoking and asbestosis. They concluded that whether asbestos or asbestosis causes the cancer remained unresolved. In their view, it did not seem reasonable to attribute the tumours simply to scarring rather than to the inhaled fibres.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a commentary, not a new study. It responded to a 1993 editorial by Dr. Andrew Churg on lung cancer and asbestosis. The authors accepted that asbestos exposure is associated with lung carcinoma. They argued it had not been established whether asbestosis (asbestos scarring of the lung) leads to these cancers, or whether both simply follow asbestos dose. They noted that studies reporting no link in workers without asbestosis did not state their statistical power and included few such cases. They cited other researchers' work. Irvine et al. concluded that about 5.7% of lung cancers in men in the west of Scotland were asbestos related. Hillerdal found a modest but statistically significant increased lung cancer risk in patients with bilateral parietal pleural plaques but no radiographic asbestosis, after smoking was taken into account. Anttila et al. linked higher lung fiber burdens to lower lobe tumors. The authors also argued that other lung scarring diseases carry lower cancer rates and different cancer types. They concluded that the question was unresolved, but that blaming the scarring alone rather than the inhaled fibers did not seem reasonable.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Commentary (opinion piece) responding to an editorial by Dr. Andrew Churg [1993]; it reports no new data
• Exposure: Asbestos exposure and asbestosis, discussed as possible causes of carcinoma of the lung in asbestos workers
• Main results:
  • The authors' view was that it had not been established whether asbestosis is the precursor lesion, or whether lung cancer and asbestosis both simply follow a dose-response relationship with asbestos exposure.
  • The authors stated that the published studies showing no relationship between lung cancer and asbestos exposure without asbestosis did not state their statistical power and included only a few such cases.
  • The authors cited Irvine et al. [1993], a study of nearly 19,000 lung cancer cases. That study concluded that approximately 5.7% of lung cancers in men in the west of Scotland are asbestos related, and that asbestosis is probably not a prerequisite. This is another study's finding.
  • The authors cited Hillerdal [1994], which found that bilateral parietal pleural plaques without radiographic asbestosis were associated with a modest but statistically significant increased lung cancer risk after smoking was taken into account. This is another study's finding.
  • The authors argued that other diffuse interstitial fibroses (idiopathic pulmonary fibrosis and collagen vascular disorder-associated fibrosis) have considerably lower cancer rates, mainly adenocarcinomas. By contrast, lung cancers in asbestos workers are indistinguishable in type from those in cigarette smokers not exposed to asbestos.
  • The authors stated that animal studies have shed little or no light on the debate.
  • The authors cited Anttila et al. [1993], in which higher tissue fiber burdens were associated with a higher proportion of lower lobe tumors, and this persisted after adjusting for smoking history and asbestosis. This is another study's finding.
• The authors' conclusion: The authors concluded that the association between asbestos exposure and lung carcinoma is indisputable. Whether asbestos or asbestosis is the causative agent remained open, but it did not seem reasonable to conclude that the scarring of asbestosis alone, rather than the inhaled fibers, induces lung tumors.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

Medical terms in this study, explained in our Lexicon: Carcinoma, Interstitial Fibrosis, Lung Cancer, Asbestos Exposure, Pleural Plaques, Basilar.

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